Recovery and Relapse Prevention

Obsessive-Compulsive Disorder: An Information Guide

On this page:

• The Process of Recovery
  • Returning to work
• Effective Relapse prevention
• Relationship with partner or spouse
• Relationship with children

The Process of Recovery

While cognitive-behavioural therapy and medication usually help reduce the symptoms of OCD, there are aspects of living with the illness that these therapies do not fully address. The process of recovery from OCD, like the onset of the illness, is gradual and ongoing.

OCD affects every part of a person's life. It may disrupt your ability to function at work, in social situations and in the family. Once the symptoms improve, and you approach a return to normal life, addressing the practical and emotional issues that may have arisen out of a long illness can be difficult.

A lengthy illness can lower a person's self-confidence, making him or her feel insecure and vulnerable in situations that were once familiar and comfortable. OCD can cause people to become quite dependent on those around them. People are often surprised at how frightened they are at the prospect of being independent and resuming their responsibilities. It is important to recognize that these reactions are a normal part of the recovery phase of OCD.

Recovery is a process, not a discrete event. At first, you should ease into familiar activities with modest expectations. Slowly take on responsibilities and build your self-confidence. When you return to activities such as socializing and going to school or work, you will probably feel anxious. Allow yourself to make mistakes.

Returning to Work

The support of a therapist can be helpful in dealing with a return to work or school, and in rebuilding relationships with family and friends. For example, you may feel quite anxious about returning to your job. Some of the work-related issues often raised by people with OCD are:

• How do I explain my absence to co-workers?
• Is it normal to feel insecure and struggle with a lack of confidence?
• How do I understand and manage these feelings and issues without needing to engage in compulsive behaviours?

You may have more, or different, questions about returning to work. Once you have raised your concerns with your therapist, work together on a strategy for a successful return to work. Ideally, your therapist should be knowledgeable about OCD. Many mental health professionals are not as informed about OCD as they are about other disorders. If a knowledgeable therapist is not available in your community, one who is open to learning about the disorder can give you the support you need.

Gradually assuming your responsibilities is highly recommended. Do this by starting back to work part-time or with a lessened workload. Your health care provider may recommend specific job accommodations that may be helpful in this transition. Typical accommodations include more frequent breaks, time off to attend medical appointments and a change in non-essential job duties.

Educating your employer and co-workers about some of the typical signs of OCD may be helpful, though some people prefer not to discuss their illness with employers. If you remain private about your illness, you will not be able to ask for any job accommodations, but it does not mean you will not be successful in your transition back to work. It can be especially important in this situation to have other people, outside of work, with whom you can discuss your problems and concerns.

Effective Relapse Prevention

OCD, like diabetes, is a chronic condition. Although the symptoms can be reduced and controlled with medication and therapy, you need to take precautions to prevent the symptoms from flaring up again.

It is important to be aware of how you are feeling. Anxiety, stress, fatigue, and feeling out of control can trigger a relapse. For some, certain situations or conditions can trigger symptoms. Another common cause of relapse is stopping medication too soon or too fast.

Once the symptoms of OCD have improved, a number of strategies can help maintain the gains you have made.

1. Become knowledgeable about OCD. Read as much as you can about OCD and its treatment. See the list of recommended reading and Internet sites at the back of this book. If there is something you do not understand, ask your mental health professionals.
2. Resist compulsive urges; learn and use healthy strategies for coping with stress and fears. Once the symptoms of OCD have improved, maintaining these gains requires commitment and determination. Unhealthy strategies for coping with stress and fears must be replaced with healthy ones. Resist the urge to perform compulsions. Using skills learned in therapy, continue to work to eliminate obsessive patterns of thought and compulsive behaviours. Do not be satisfied with only partial improvement of symptoms. This leaves you vulnerable to relapse.
3. If medication has been prescribed, continue to take it until your doctor advises you otherwise. When patients begin to feel better, they often stop taking medication. Relapse is more likely if you stop taking your medication too soon. Doctors usually recommend medication be taken for six months to a year. In some cases, antidepressants may be recommended for several years. If you are experiencing side-effects, you may be tempted to stop taking your medication. Rather than making decisions on your own, work with your doctor to develop a treatment plan you can live with.
4. Involve some family and friends in your recovery. If you allow yourself to become isolated and keep your inner world a secret, you will create an ideal breeding ground for symptoms of OCD. When family and friends are aware and involved in your struggle, they can help in a number of ways. For example, they can help you control compulsive urges; they can help you guard against a reoccurrence of symptoms, and they can give you support and encouragement.
   
   Who you tell about your illness is a very personal choice. As a buffer against relapse, however, it is important to have at least one person you can rely on and in whom you can confide. Along with family, friends and professional support, many people struggling with OCD find that self-help and support groups are a valuable part of their social network. (See the Associations listings in the Resources list for information on how to find out if there is an OCD group in your community.)
5. Adopt a healthy lifestyle that includes proper nutrition, exercise and good sleep habits. Your eating, sleeping and exercise habits play a role in how you feel and in your ability to handle stress. Nourishing yourself physically, emotionally and spiritually helps you to feel alert and calm and able to deal with problems as they arise. Yoga and other movement therapies and meditation reduce anxiety. They can also increase energy, concentration and a feeling of well-being.
6. Try to develop a well-balanced life with enough time for work, family, friends and leisure activities. It might seem easy at first to escape from OCD by focusing entirely on one area, such as work, or a hobby. Eventually, though, this coping strategy may not work and you will need to develop other aspects of your life. It is important to keep in contact with all the facets of our lives, such as school, work or volunteer activities, family and friends, and hobbies. As you recover, investing energy into several areas will help you develop a more balanced and satisfying lifestyle, which will help you to avoid relapse.
7. Get follow-up treatment. Continuing with treatment, even when the symptoms have improved, can help maintain those gains and prevent a relapse. Depending on your needs, you may also benefit from individual, group or family therapy, or a support group.
8. Plan for your time and your future. The struggle with OCD can eat up your time and distract you from thinking about your future.When the symptoms improve, it can be difficult to know what to do with the time that is suddenly available to you. The possibilities can seem endless and perhaps overwhelming.
   
   Building a life that is not absorbed by OCD depends on engaging in activities that matter to you and will help you maintain the gains you've made. Some people may be able pick up where they left off, and return to work, studies or other interests that were set aside by the illness. For others, the choice may be more difficult. In some cases, seeking the services of an occupational therapist or career counsellor can help narrow the possibilities and make choices that let you look forward to the days to come.
9. Prepare for setbacks. If you continue to practise the skills learned in therapy, and follow the tips in the points above, OCD will probably not gain control of your thoughts and actions again. However, with OCD, the possibility of relapse is always there. If you feel as though OCD is beginning to take over your life again, take action. Have a plan for early intervention. Consult with your doctor or therapist. An adjustment in medication, or revisiting some of the behavioural strategies learned in therapy, can avert a full relapse.

Relationship with a Partner or Spouse

OCD can affect your relationship with a partner or spouse. During the stage of the illness when symptoms are moderate or severe, it may be hard to be supportive and intimate with your partner. Over time, this can lead to distance and even hostility in the relationship. It takes time and work to rebuild what might have been lost during the worst stages of the illness, and while the affected person was in treatment.

Couple therapy with a marital/couple therapist who knows about OCD can be very helpful. A therapist open to learning about OCD can also be highly effective. You may need someone to help you talk about the problems in the relationship constructively, rather than angrily. A good therapist can open up communication and help couples rediscover what brought them together in the first place. OCD is an illness that must be managed over a person's lifetime. It affects people's activities and goals. Couples may need to grieve the loss of what they imagined their relationship would be like. They may need a new vision of how they will move forward together.

Relationship with Children

At its worst, OCD can really affect your personal relationships. OCD might affect your ability to act as a parent. Routine things such as changing diapers, preparing meals or spending time with your children might become very difficult. You may become isolated from your children's social network and need to reconnect to school staff, extracurricular activities and neighbours. What, if anything, do you say to people? Your role as parent can be difficult to readjust to when you are recovering from an illness. Talking with a therapist can help you to manage any anxiety that may arise.

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